Healthcare Provider Details

I. General information

NPI: 1346864923
Provider Name (Legal Business Name): MOBILE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2020
Last Update Date: 05/30/2020
Certification Date: 05/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N THE GREENS AVE
NEWBERG OR
97132-7464
US

IV. Provider business mailing address

319 N THE GREENS AVE
NEWBERG OR
97132-7464
US

V. Phone/Fax

Practice location:
  • Phone: 503-487-6221
  • Fax: 503-683-8071
Mailing address:
  • Phone: 503-487-6221
  • Fax: 503-683-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL KANG
Title or Position: CEO
Credential: PT, DPT
Phone: 503-487-6221